APPENDIX I
(See Paragraph-6)
FORM 1M
Note : If space provided against any parameter is inadequate,Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form 1M. Please note that all such Annexures must be part of single pdf document.
(I)Basic Informations
S.No.Item Details
(i).Name of the Mining Lease site Building Stone Quarry of Mr Abdul Rahim
(ii).Location / site (GPS Co-ordinate) 11°20'18.38"N to 11°20'25.61"N 75°58'28.65"E to 75°58'39.74"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3.8830 ha.
(iv).Capacity of the Mining Lease (TPA) 124256
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 50
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DMG/KERALA/RQP/7/2016 
Name of Consultant/RQPNazar Ahamed K V
Address Nsquare Mining and Environmental Solutions LLP,Xaithoon Complex, Edappal po,Malappuram
Mobile No.8547097533
Landline No.2677533
Email Idgeologistna@gmail.com
(II) Environmental Sensitivity
S.No Areas Distance in kilometer / Details
1. (i).  Nearest rail or road bridge over the concerned river,rivulet,nallah etc. in kms.  1.6 km
2. (ii). Nearest Infrastructural along with distance in kms  .450 km
(iii). Nearest Railway Line along with distance in kms  27 km
(iv). Nearest National Highway along with distance in kms  20 km
(v). Nearest State Highway along with distance in kms  .600 km
(vi). Nearest Major District Road along with distance in kms 1.6 km
(vii). Nearest Any Other Road along with distance in kms  1.6 km
(viii). Nearest Electric transmission line pole or tower distance in kms  .450 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  50 km
(x). Nearest In-take for drinking water pump house distance in kms  10.5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  10.5 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None within 1KM from project side
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Iruvazhainjai River-1.6KM,Kozhikode Coastal Area-26KM,Thiruvambadi Mountains-5KM
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 1KM from project side
6. Inland, coastal, marine or underground waters Kozhikode Coastal Area-26KM
7. State, National boundaries Kerala-Tamilnadu-53KM
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Thusharagiri-17KM,Vellarimala Eco Tourism-17KM,Kakkadampoyil Water falls-15KM
9. Defence installations None within 1KM from project side
10. Densely populated or built-up area, distance from nearest human habitation 72.9M towards north west side from the area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital-Agasthyamuzhi-1.5KM, Airport- Calicut International Airport-34KM, School-Pallotto School Agasthyamuzhi-1.3KM, Church-Mukkom-2KM, Mosque-Manapoyil-600M.Temple-Vattoliparambu Temple-1.2KM
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Thusharagiri-17KM,Vellarimala Eco Tourism-17KM,Kakkadampoyil Water falls-15KM
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No
14. Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) No
15.
Is proposed mining site located over or near fissure/fracture for ground water recharge?No
16.
Whether the proposal involves approval or clearance under the following Regulations or Acts namely?
(a).
The Forest (Conservation) Act,1980?No
(b).
The Wildlife (Protection) Act,1972?No
(c).
The Coastal Regulation Zone (C.R.Z) notification,2011?No
17.
Is forest land involved (ha)?No
18.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
19.
New/Expansion/ModernizationNew
Proposal NumberDIA/KL/MIN/18283/2018
File NumberH/6739/2018
Date of Apply EC17 Oct 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKozhikodeKozhikode
(III) EC Attachments
1 Uploaded PFR (Pre Feasibility Report) File Annexure-PFR file
2 Uploaded Approved Mining Plan File Annexure-Approved Mining Plan file
3 Uploaded District survey report Annexure-District Survey Report
4 Uploaded Cover Letter Annexure-Cover Letter
Uploaded Additional attachments, if any
S.No. Attached File Date of Submission
(1.)Form 1M17 Oct 2018
(2.)Tax&Possession17 Oct 2018
(3.)RQP Certificate17 Oct 2018
(4.)LOI&ID Proof17 Oct 2018
(5.)Consent Letter17 Oct 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR ABDUL RAHIM
DesignationProprietor
Company BUILDING STONE QUARRY OF MR ABDUL RAHIM
AddressThazhakkode Village, kozhikode Taluk,Kozhikode District
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